Williams N S, Marzouk D E, Hallan R I, Waldron D J
Surgical Unit, London Hospital, Whitechapel, UK.
Br J Surg. 1989 Nov;76(11):1168-71. doi: 10.1002/bjs.1800761119.
Fourteen patients with ulcerative colitis underwent formation of an S ileal pouch and construction of a stapled pouch-anal anastomosis by a modified technique, which eliminated the use of purse-string sutures. Eleven have had their covering ileostomies closed. Anal manometry performed before and a median of 9 months after ileostomy closure showed significant impairment of internal anal sphincter function. Night evacuation was significantly reduced in the stapled group compared with a similar group of patients who had undergone S ileal pouch formation, mucosal proctectomy and manual transanal anastomosis, but this was the only parameter of function to show a difference. A stapled pouch-anal anastomosis may be superior to the conventional procedure but it still may lead to internal anal sphincter damage which cannot be due to mucosectomy or prolonged anal retraction.
14例溃疡性结肠炎患者采用改良技术进行S形回肠贮袋成形术及吻合器行贮袋肛管吻合术，该技术无需使用荷包缝合。11例患者的覆盖性回肠造口已关闭。在回肠造口关闭前及关闭后中位时间9个月进行的肛门测压显示，肛门内括约肌功能明显受损。与一组接受S形回肠贮袋成形术、黏膜直肠切除术及手工经肛门吻合术的类似患者相比，吻合器组的夜间排便明显减少，但这是唯一显示有差异的功能参数。吻合器行贮袋肛管吻合术可能优于传统手术，但仍可能导致肛门内括约肌损伤，这并非黏膜切除或长时间肛门牵拉所致。
